NCLEX Review Guide: Sexually Transmitted Infections in Pregnancy

High-Risk STIs During Pregnancy

• Chlamydia and Gonorrhea are the most common bacterial STIs affecting pregnant women and can cause preterm labor, PROM, and neonatal conjunctivitis.
• Syphilis can cross the placenta at any gestational age and cause congenital syphilis, stillbirth, or neonatal death if untreated.
• Herpes Simplex Virus (HSV) poses greatest risk during active outbreak at delivery, requiring cesarean section to prevent neonatal transmission.
• Human Papillomavirus (HPV) can cause genital warts that may grow larger during pregnancy due to hormonal changes.

Chlamydia and Gonorrhea

• Chlamydia is treated with azithromycin 1g PO single dose or amoxicillin 500mg TID x 7 days during pregnancy. Doxycycline is contraindicated due to tooth discoloration in fetus.
• Gonorrhea requires ceftriaxone 250mg IM single dose plus azithromycin for dual therapy to prevent resistance.
• Test of cure is required 3-4 weeks after treatment completion to ensure bacterial eradication.

Syphilis Management

• Primary, secondary, and early latent syphilis are treated with benzathine penicillin G 2.4 million units IM single dose.
• Late latent or unknown duration syphilis requires benzathine penicillin G 2.4 million units IM weekly x 3 doses.
• Jarisch-Herxheimer reaction may occur 6-12 hours after treatment, causing fever, headache, and myalgia - monitor closely.

Herpes Simplex Virus (HSV)

• Suppressive therapy with acyclovir 400mg PO BID starting at 36 weeks reduces outbreak frequency and viral shedding at delivery.
• Active genital lesions at delivery require cesarean section to prevent neonatal herpes transmission, which has 60% mortality rate.
• Primary outbreak during pregnancy poses higher transmission risk than recurrent episodes due to higher viral load.

1. Assess for prodromal symptoms (tingling, burning) before delivery
2. Perform careful inspection of genital area during labor
3. If active lesions present, prepare for immediate cesarean delivery
4. Isolate newborn if vaginal delivery occurred with active lesions

Prevention Strategies

• Routine screening at first prenatal visit includes syphilis, chlamydia, gonorrhea, HIV, and hepatitis B surface antigen.
• High-risk women (multiple partners, previous STI, substance use) require repeat screening in third trimester.
• Eye prophylaxis with erythromycin ointment is required for all newborns within 1 hour of birth to prevent gonococcal ophthalmia.

Patient Education Priorities

• Medication compliance is crucial - emphasize completing full antibiotic course even if symptoms resolve to prevent treatment failure.
• Partner notification and treatment prevents reinfection and breaks transmission cycle in community.
• Safe sex practices including consistent condom use and limiting sexual partners reduces STI transmission risk.
• Return for follow-up testing as scheduled to ensure treatment effectiveness and monitor for reinfection.

Common Pitfalls

Self-Check Questions

• ☐ I can identify safe antibiotics for STI treatment during pregnancy
• ☐ I understand when cesarean delivery is indicated for HSV
• ☐ I know the screening schedule for STIs in pregnancy
• ☐ I can explain the importance of partner treatment
• ☐ I understand complications of untreated STIs in pregnancy